Impact of estimated pulse wave velocity and socioeconomic status on the risk of stroke in men: a prospective cohort study

Objective: High pulse wave velocity (PWV) and low socioeconomic status (SES) are each associated with increased risk of stroke, but clarification of the interplay between PWV, SES and the risk of stroke appears to be warranted in order to identify vulnerable populations at high risk of stroke. We conducted a prospective study that examined the independent and joint associations of PWV and SES with the risk of stroke in the general population. Methods: This study included 2666 men aged 42-61 years, who were enrolled in the Kuopio Ischaemic Heart Disease Study cohort. Estimated pulse wave velocity (ePWV), a proxy of carotid-femoral pulse wave velocity, was calculated from an equation based on age and mean blood pressure. SES was assessed using self-reported questionnaires and classified as tertiles, while ePWV was categorized as high (≥10 m/s) and low (<10 m/s). Results: Individuals with high ePWV had a 48% higher risk of stroke after adjusting for confounding factors, while individuals with low SES had a similar 35% increased risk of stroke, compared with those high SES. Results of the joint associations of ePWV and SES with stroke showed high ePWV-high SES and high ePWV-low SES to be each associated with an increased risk of stroke: hazard ratios (HRs) 1.53, 95% confidence intervals (CIs) (1.12-2.08) and HR 1.63, 95% CI 1.21-2.20), respectively, but low ePWV-low SES was not associated with a heightened risk of stroke (HR 1.12, 95% CI 0.87-1.44) compared with the low ePWV-high SES group. Conclusion: ePWV and SES are each independently associated with stroke risk. The association between elevated ePWV and the heightened risk of stroke is regardless of low or high SES.